Hip fracture

Definition

You can break your hip at any age, but the great majority of hip fractures occur in people older than 65. As you age, your bones slowly lose minerals and become less dense. Gradual loss of density weakens bones and makes them more susceptible to a hip fracture.

A hip fracture is a serious injury, particularly if you're older, and complications can be life-threatening. Fortunately, surgery to repair a hip fracture is usually very effective, although recovery often requires time and patience.

Hip fractures

Hip fractures

Most hip fractures occur in one of two locations — the femoral neck or the intertrochanteric region. ...

Symptoms

Signs and symptoms of a hip fracture include:

• Immobility immediately after a fall
• Severe pain in your hip or groin
• Inability to put weight on your leg on the side of your injured hip
• Stiffness, bruising and swelling in and around your hip area
• Shorter leg on the side of your injured hip
• Turning outward of your leg on the side of your injured hip

Causes

In older adults, a hip fracture is most often a result of:

• Falling
• Sustaining a blow to the hip joint, as in a car accident
• Having weak bones

Risk factors

A combination of factors may increase your risk of a hip fracture, including:

• Age. The rate of hip fractures increases substantially with age. As you age, your bone density decreases, your vision and sense of balance decline, and your reaction time slows. If you're inactive, your muscles tend to weaken as you age. All of these factors combined can increase your risk of a hip fracture. Almost 9 out of 10 hip fractures occur in people older than age 65.
• Sex. About 80 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do. The drop in estrogen levels that occurs with menopause accelerates bone loss, increasing the risk of hip fractures as a woman moves beyond menopause. However, men also can develop dangerously low levels of bone density.
• Chronic medical conditions. Osteoporosis is the most significant and well-known risk factor for hip fracture, but other medical conditions may increase your risk of bone fragility. These include endocrine disorders, such as an overactive thyroid, and intestinal disorders, which may reduce your absorption of vitamin D and calcium.
• Certain medications. Some drugs, typically those used for chronic conditions such as high blood pressure and asthma, have a gradual effect on your bone health when you take them long-term.
• Nutritional problems. Lack of calcium and vitamin D in your diet when you're young lowers your peak bone mass and increases your risk of fracture later in life. Serious eating disorders, such as anorexia nervosa and bulimia, can damage your skeleton by depriving your body of essential nutrients needed for bone building.
• Physical inactivity. Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. If you don't regularly participate in weight-bearing exercise, you may have lower bone density and weaker bones. Additionally, prolonged bed rest or immobility can lead to bone loss.
• Tobacco and alcohol use. Smoking and excessive consumption of alcohol can interfere with the normal processes of bone building and remodeling, resulting in bone loss.

Complications

A hip fracture is a serious injury. Although the fracture itself is treatable, complications can be life-threatening. If you also have an illness that makes it unsafe to undergo surgery to repair your broken hip, your doctor may use a tension system (traction) to allow your hip to heal.

The most significant risk of traction is that it may lead to muscle deterioration and weakness, increasing the likelihood of permanent loss of mobility. In addition, traction keeps you immobile for a long period, during which time you can develop blood clots in the veins of your legs. The affected vein may be near the surface of your skin, causing superficial thrombophlebitis, or deep within a muscle, causing deep vein thrombosis.

You can also develop a blood clot after hip surgery if you don't get up and move around very much. It's possible for a blood clot to become lodged in a pulmonary artery, blocking blood flow to lung tissue. This condition, called pulmonary embolism, can be fatal.

Risks of traction and being immobile include:

• Blood clots
• Bedsores
• Urinary tract infection
• Pneumonia
• Muscle wasting

Additionally, people who've had one hip fracture have a significantly increased risk of having another one.

Preparing for your appointment

If you've fallen or otherwise injured your hip, call 911 or emergency medical help. Wait for paramedics to move you safely.

Have a family member or friend come with you, if possible. Someone who accompanies you can help soak up all the information provided during your evaluation.

What to expect
Rescue and hospital staff are likely to ask these and similar questions:

• Have you recently fallen or had another injury to your hip?
• What are your symptoms?
• How severe is your pain?
• Can you put weight on your leg on the side of your injured hip?
• Have you been diagnosed with any other medical conditions?
• Have you had a bone density test?
• What medications are you currently taking, including vitamins and supplements?
• Do you use alcohol?
• Do you smoke?
• Do you use recreational drugs?
• Have you had surgery in the past? Were there any problems?
• Do any of your first-degree relatives — such as a parent or sibling — have a history of bone fractures or disorders, such as osteoporosis?
• Are you currently living independently?

Tests and diagnosis

Often your doctor can determine that you have a hip fracture based on your symptoms and by observing the abnormal position of your hip and leg. An X-ray usually will confirm that you have a fracture and show exactly what part of your hip is fractured.

If your X-ray doesn't show a fracture but you still have hip pain, your doctor may order a CT or MRI scan to look for a small hairline fracture.

Most hip fractures occur in one of two locations along your femur, the long bone that extends from your pelvis to your knee:

• The femoral neck. The femoral neck is located in the upper portion of your femur, just below its head, which is the ball part of the ball-and-socket joint.
• The intertrochanteric region. This region is the portion of your upper femur that juts outward.

Hip fractures

Hip fractures

Most hip fractures occur in one of two locations — the femoral neck or the intertrochanteric region. ...

Treatments and drugs

Treatment for hip fracture often involves a combination of three approaches, including:

• Surgery
• Rehabilitation
• Medication

Surgery
Surgery is almost always the best hip fracture treatment. Doctors typically use nonsurgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky.

The type of surgery you have generally depends on the part of the hip that fractured, the severity of the fracture and your age. Generally, the better your health and mobility before your hip fracture, the better your chances for a complete recovery from a hip fracture.

Femoral neck fractures
Doctors repair this type of fracture by one of three methods:

• Metal screws. If, after the break, the bone is still properly aligned, your doctor may insert metal screws into the bone to hold it together while the fracture heals. This is called internal fixation. Often metal screws are placed in combination with bone nails (gamma nails) for additional stability.
• Replacement of part of the femur. If the ends of the broken bone aren't properly aligned or they've been damaged, your doctor may remove the head and neck of the femur and replace them with a metal prosthesis. This is known as hemiarthroplasty.
• Total hip replacement. This procedure involves replacing your upper femur and the socket in your pelvic bone with prostheses. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function prior to the fracture.

Although older age increases the likelihood that you'll need hip replacement, the most significant factors in determining whether you need this procedure are:

• The type of fracture you have
• The severity of your signs and symptoms
• Your personal risk of surgery-related problems
• Your mobility and ability to function independently before the fracture

Intertrochanteric fractures
To repair this type of fracture, your doctor usually inserts a metal screw (hip compression screw) across the fracture. The screw is attached to a plate that runs down alongside the femur. This plate is attached with other screws to help keep the bone stable. As the bone heals, the screw allows the bone pieces to compress, so the edges grow together.

Depending on the type of fracture, your doctor may first place a bone nail (gamma nail) down the shaft of your bone, and then pass compression screws through the nail. The nail helps prevent sliding and provides additional stability, and it may enable you to bear weight earlier.

Rehabilitation
If you're having a normal recovery from surgery, the next steps will likely follow this schedule:

• Within about 1 day after surgery. Your care team will help you get up and moving, often with the help of a walker. You'll begin physical therapy, typically with a focus on range of motion and strengthening exercises.
• Within about 1 week after surgery. Hospital stays after hip fracture surgery generally last less than a week. Depending on the type of surgery you had and whether you have assistance at home, you may need to go from the hospital to an extended care facility.
• Within 1 month after surgery. In extended care and at home, you may work with an occupational therapist to learn techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. Your occupational therapist will determine if a walker or wheelchair may help you regain mobility and independence.

Ongoing, you may continue to meet with a physical therapist and occupational therapist as you recover from surgery.

Medication
While surgery is the primary treatment for a hip fracture, a group of bone density-enhancing medications called bisphosphonates may help reduce the risk of a second hip fracture. Most of these drugs are taken orally and are associated with side effects that may be difficult to tolerate, including nausea, abdominal pain and inflammation of the esophagus. As an alternative, one bisphosphonate, zoledronic acid (Reclast), can be given as a yearly infusion.

Hip fracture repair

Hip fracture repair

For a fracture in the femoral neck, internal fixation, hemiarthroplasty or a total hip replacement may be used. A hip compression screw may be used for a fracture in the intertrochanteric region. ...

Prevention

Healthy lifestyle choices during peak bone-mass-building years — which end when you're about 30 — contribute to a higher peak bone mass and reduce your risk of osteoporosis in later years. The same measures may lower your risk of falls and improve your overall health if you adopt them at any age.

Build and protect bone mass

• Ensure adequate calcium and vitamin D in your diet. Your age, medications, health conditions and normal daily diet are among the factors that influence how much calcium and vitamin D supplementation you may need. If you're considering calcium or vitamin D supplements, ask your doctor about what's an appropriate dose for you.

  As a general rule, experts recommend that men and women age 50 and older consume 1,200 milligrams of calcium a day, and 400 to 600 international units (IU) of vitamin D a day. Experts also suggest getting 10 to 15 minutes twice a week of unprotected sun exposure to ensure adequate levels of vitamin D.

• Exercise to strengthen bones and improve balance. Weight-bearing exercises, such as walking, encourage your body to increase bone density. Exercise also increases your overall strength, making you less likely to fall. Try to exercise for 30 minutes a day on most days of the week.

  Balance training is also key to reducing your risk of falls, since balance tends to deteriorate with age. Certain training exercises are especially effective at helping you maintain and improve balance. Try standing on one leg for increasing periods of time to improve your overall stability. Activities such as tai chi can promote balance, too.

• Don't drink excessively or smoke. Preserve your bone density by avoiding the excessive use of alcohol and by not smoking.

Lower your risk of falls

• Assess your home for fall hazards. Remove throw rugs, keep electrical cords against the wall, and clear excess furniture and anything else that could trip you. Make sure every room and passageway is well lit.
• Get your eyes checked every other year, or more often if you have diabetes or an eye disease.
• Be mindful of side effects of medications. Feeling weak and dizzy, which are possible side effects of many medications, can increase your risk of falling. Talk to your doctor about side effects caused by your medications.

Lifestyle and home remedies

Recovering from a hip fracture involves a lengthy period of rehabilitation. The goal of rehabilitation is to help you regain mobility. You'll learn how to gradually place more weight on your hip until it can handle your full weight without pain. You'll also learn how to sit, stand and walk so that you don't re-injure your hip or damage your prosthesis, if you have one.

Help with walking and other activities
After a hip fracture, you'll need the help of a walking aid, such as a cane, walker or crutches, for a while. You may also need help getting around your home and doing daily tasks, such as bathing, dressing and cooking. Or, you may need to enter an extended care facility while recuperating to get assistance that's not available at home.

You can help speed the healing process and increase your chances for a full recovery by following your doctor's and therapist's instructions and taking good care of yourself.